Retrospective Cohort Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Sep 18, 2016; 7(9): 553-560
Published online Sep 18, 2016. doi: 10.5312/wjo.v7.i9.553
Surgical treatment of Lenke 5 adolescent idiopathic scoliosis: Comparison of anterior vs posterior approach
Mark F Abel, Anuj Singla, Mark A Feger, Lindsay D Sauer, Wendy Novicoff
Mark F Abel, Anuj Singla, Mark A Feger, Lindsay D Sauer, Wendy Novicoff, Department of Orthopedic Surgery, University of Virginia, Charlottesville, VA 22908, United States
Author contributions: All the authors contributed to this paper.
Institutional review board statement: The study was reviewed and approved for publication by respective Institutional Reviewer Boards.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All the authors have no conflict of interest related to the manuscript.
Data sharing statement: The original anonymous dataset is available on request from the corresponding author at anujrajsingla@gmail.com.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Anuj Singla, MD, Department of Orthopedic Surgery, University of Virginia, P.O. Box 800232, Charlottesville, VA 22908, United States. anujrajsingla@gmail.com
Telephone: +1-434-2430291 Fax: +1-434-2431539
Received: March 22, 2016
Peer-review started: March 23, 2016
First decision: May 16, 2016
Revised: July 19, 2016
Accepted: July 29, 2016
Article in press: August 1, 2016
Published online: September 18, 2016
Processing time: 174 Days and 8.5 Hours
Abstract
AIM

To compare the posterior vs anterior approaches for fusion of Lenke 5 adolescent idiopathic scoliosis curves, matched for curve magnitude and for the distal level of fixation (dLOF) standardized to the third lumbar vertebrae (L3).

METHODS

A prospectively collected multicenter database was used for this retrospective comparative study. Our dependent variables included sagittal and coronal radiographic measurements, number of fused vertebrae, estimated blood loss, length of hospitalization and SRS total and individual domain scores at the two-year follow-up. Subject demographics were similar for all group comparisons. Independent t-test was used to compare groups for all analyses at P < 0.01.

RESULTS

For all matched cases of Lenke 5 curves, a selective approach was used only 50% of the time in cases undergoing a posterior fusion. When comparing a posterior selective approach to an anterior selective approach, surgeons utilizing a posterior approach fused significantly more levels than surgeons using an anterior approach with no other significant differences in radiographic or SRS outcomes (Ant = 4.8 ± 1.0 levels vs post = 6.1 ± 1.0 levels, P < 0.0001). When the dLOF was standardized to L3, the anterior approached provided significantly greater lumbar Cobb percent correction than the posterior approach (Ant = 69.1% ± 12.6% vs post = 54.6% ± 16.4%, P = 0.004), with no other significant radiographic or SRS score differences between approaches.

CONCLUSION

Surgeons treating Lenke 5c curves with a posterior instrumentation and fusion vs an anterior approach include more motion segments, even with a selective fusion. When controlled for the distal level of fixation, the anterior approach provides greater correction of the thoracolumbar curve.

Keywords: Instrumentation; Thoracolumbar curve; Selective fusion

Core tip: A multicenter database was analyzed to determine the frequency that surgeons performed a selective fusion of the thoracolumbar (TL)/lumbar curve in adolescent idiopathic scoliosis patients with Lenke 5c curves. We found that surgeons treating Lenke 5c curves will include more motion segments when employing a posterior approach. When controlled for the distal level of fixation, the anterior approach provides greater correction of the TL curve.